Provider Demographics
NPI:1841663036
Name:GILMORE, LORETTA LYNN (MSW,LCSW)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:LYNN
Last Name:GILMORE
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:LYNN
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:473 MOSS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-2266
Mailing Address - Country:US
Mailing Address - Phone:859-312-6569
Mailing Address - Fax:
Practice Address - Street 1:1050 CHINOE RD STE 112
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-6571
Practice Address - Country:US
Practice Address - Phone:859-312-6569
Practice Address - Fax:855-594-5062
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
KY51471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty